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Saturday, August 24, 2013

God Gave us Clear Answers! A new emergency surgery!

Warning: this is a long, detailed post. By Thursday night, we had lots of questions to which we needed answers. But, let me update you first on some of the issues from our last post.

Falling down patio cover:
The guy who originally built our patio cover checked out the issue on Wednesday. He admitted to not properly anchoring it and said he would fix it for us. He brought someone to help him out this morning and began the repair. That deserves a "Praise the Lord" as we were honestly concerned he would not show up. The quote from someone new to fix it was very costly. With all of these exorbitant cancer treatment costs and with me not currently working, these unexpected add-on expenses are an extra burden.

Drew's Car:
Drew's car is still running well and we haven't seen a "check engine" notice light since the last repair. Praise the Lord!

My wound that doesn't want to heal:
And now, for the areas where we had questions. On Wednesday, I noticed my left breast began looking red and felt a little warm to the touch. Although it still appeared to be stitched, I thought it would be a good idea to check out a new wound care clinic prior to my appointment at the other new wound care center, which was scheduled for the following Wednesday. The wound care center was able to get me in at 8am the following morning (Thursday) to see their physician. The physician actually used to work with my plastic surgeon. So, he was a trained plastic and reconstructive surgeon. But, he also had training at burn centers and in hyperbaric treatment. I saw him Thursday morning and he seemed very knowledgable. After examining my wound, he asked me if I wanted him to be honest with me. I replied, "yes, of course, I want you to give me your honest opinion!" He said, we need to be VERY AGGRESSIVE with your treatment. Apparently it was a pretty serious issue. It was such a different response from the previous wound care specialist's opinion I had sought. This physician ended up removing a couple of stitches and stuck the wooden end of a sterile cotton swab into the hole. This released a TON of fluid that had built up. He also injected a ton of silva gel. Silva gel is an antimicrobial wound hydrogel that releases ionic silver to kill off a wide range of bacteria and fungi. By the time he was finished, the wound was wide open and looked worse. He recommended I receive hyperbaric treatment, because he said I had a lot of things working against me in getting the wound to heal on its own. For one, the wound was on radiated skin. Radiation shrinks the blood vessels. With the blood vessels shrunk, red blood cells (which carry oxygen) have difficult getting through to the wound to repair the skin. Instead, the wound only gets mainly plasma. Hyperbaric treatment would get concentrated oxygen into my blood stream, so at least some oxygen could get through the vessels to help repair the wound. However, he wasn't even too optimistic that this would work, because I had some other things working against me. I had the implant under the skin pushing out. So, it is very difficult for the radiated skin to heal when something was trying to stretch it out. Also, it seemed an infection might be brewing. He said that implants do not foster a sterile environment. The physician said he optimistically would give it a 50/50 chance for this wound to heal after treating the wound aggressively with his regimen of hyperbaric treatments and topical treatments. Not only that, but the hyperbaric treatment would be very time consuming and extremely expensive (thank goodness we met our out-of-pocket maximum for the year). It would take about 3.5 hours a day for me to have the treatment (30 minutes to drive to the clinic, 2 hours in the hyperbaric chamber, plus 30 minutes for preparing to get in and getting out and my clothes back on, etc. and 30 minutes to drive home from the clinic). And, there would be 30-40 treatments, M-F. So, this would be anywhere from 6-8 weeks of the 3.5 hour weekday routine. I headed home after my appointment and discussed this with Drew.

About an hour after my appointment, I was in excruciating pain in the area where the physician poked and prodded around. I called their office later that afternoon and he agreed to see me right away. He said it didn't look bad and that I would be fine. He told me that likely it was the pressure from the gel he injected that was causing the pain. To me, my skin which was once slightly warm and slightly pink was now dark red/purple and extremely warm to the touch. It certainly didn't look fine to me. I also now had a huge open wound. I asked him what he would recommend for me to do if I were his wife, daughter or sister. He said, "I would get the implant out." He said he would put in its place an expander in expanded to about half the size of the current implant (I didn't even know they could get that small!). Then, he would also do 30 treatments of hyperbaric treatment (he recommended 20 treatments prior to surgery and 10 after). So, this would mean another surgery.

Leaving that appointment, Drew and I had a lot of new questions on how to proceed. The whole reason I had the expanders put in and went through that process prior to radiation is because every physician I discussed it with said that they had not seen a successful implant reconstruction post radiation without beginning the reconstruction (expander placement) prior to radiation. I was also told that that was likely the only option for me for reconstruction due to my size. The flap surgeries, which are the more popular option for women who undergo radiation treatment, utilize your own body fat and tissue to create breasts. This surgery has a pretty long recovery time though (approx. 6-8 weeks) and there are also risks with it. So, after much contemplation and discussion with others, we decided to go for the expander reconstruction. Now, if I removed the implant, it seemed my only option would be to use my own tissue down the road in a new reconstruction surgery. Since my skin likely would not expand well.

So, what would we do? Here are the options we discussed.

1. Remove the implant and just let it heal?
2. Try the treatment regimen recommended by the wound care center (hyperbaric and topical treatments) and see if we can help it heal without removing the implant. This would prevent us from having more surgeries.
3. Have some hyperbaric treatments prior to having the implant exchanged with an expander, expanded to about half the size of the implant. Then, follow up with more hyperbaric treatments to get it to heal.
4. Get another plastic surgeon's opinion who specialized in the flap surgeries--could I try the flap surgery on just that one side? Would I have enough tissue to remove to create a breast just on that one side?

We prayed a lot about it on Thursday night. We called both sets of parents and asked for their prayer as well. We began getting answers fairly quickly.

At 5am on Friday, I noticed I had fluid leaking pretty rapidly from my bandaged left breast wound. I went into the bathroom to change out the bandage. When I removed the bandage, the wound looked like an open fire hydrant, with silva gel and TONS of fluid pouring out of it. It wasn't stopping but was continuously flowing. I noticed I also felt terrible. I was extremely nauseous. I grabbed the thermometer to take my temperature and found out I had a fever (101.8, which is pretty high for my normal body temperature of 97). I wasn't sure what to do. My plastic surgeon's office didn't open their phone line until 8:30am and I knew he was in surgery all day on Fridays anyway. I thought the wound looked AWFUL and knew he would think so also. I contacted the wound care center that I had visited the previous day since they opened earlier than my surgeon's office. After discussing it with them, they recommended just taking tylenol to see if my fever would go down and they recommended I try to eat and drink something. My concern was not the fever, but what was causing it. I know because of the experiences with other women who have undergone reconstruction surgeries that infections can quickly get into your bloodstream and cause sepsis and potentially death. I have heard from women who had similar experiences as what was experiencing and soon found themselves in the hospital in near death-experiences. In fact, did you know that 70% of all surgery-related complication deaths are due to infection? I knew I had to act on this fast, because once it gets into your blood system, it truly can be fatal. It is especially bad on someone with a compromised immune system (like mine--my white blood counts were still low when I got my last lab results). I finally was able to get in touch with the nurse at my plastic surgeon's office a little before 9am. I also emailed her a photo of the wound, which was open the size of a dime or larger. She was very concerned and said that she would need to email the physician, since he was in surgery. She asked me not to eat or drink anything in case the doctor wanted to do surgery on me immediately. I had already had a couple of bites of granola and a little green tea around 8am, so I didn't consume anything else.

Around 10:40am, the nurse called and said that surgery (to remove the implant, repair the wound and remove any present infection) was scheduled for 2pm, and I needed to be there by 12pm. This meant we needed to leave the house by 11:30! I had to do surgery prep and we had to figure out how the kids would be taken care of. Drew was very busy with conference calls and work so it was a pretty hectic morning. But, our friends took all of the potential stressors away! They. Are. Amazing! Our church community group rushed together and took care of us. 5 different girls took shifts in watching after the kids, beginning around 11:10. All of these wonderful girls have children of their own and other responsibilities as well, so this was definitely an appreciated sacrifice! We had so much peace knowing that our kids were being well-taken care of in this urgent time of need. Drew and I literally had tears in our eyes witnessing the love that was being shown to us that day. As we arrived to the hospital, Drew got a text from a friend from church, and elder. He had picked up an awesome, big lunch for Drew at Rudy's bbq. How did he even know our need? Amazing! We had actually tried to find something fast that was on the way to the hospital where Drew could pick up food since he hadn't yet ate lunch (and wouldn't be able to leave for a long time), but were not successful and didn't want to be late. He brought up the lunch and the then he and another elder from church prayed with us before the admission employee brought us back to my surgery prep room.

The surgery went very well. The surgeon removed the implant and could see that an infection was definitely brewing. When the wound care center doctor stuck the sterile wooden stick in he likely opened up a pocket of infected fluid. It had likely gotten into my blood stream a bit, which is why I had the fever, etc. But, they administered intravenous antibiotics, and he poured a liquid antibiotic in the area during surgery. I am also still currently taking an oral antibiotic. So, whatever infection was brewing should be on its way out! We were able to leave the hospital with one less implant and one new drain tube around 5:45p.

We arrived home to really happy kiddos who were being watched by two of our awesome friends (they had the late afternoon shift). I think our kids really enjoyed having all of the fun visitors to our house yesterday. This makes me so happy!

So, what now? I have only one breast-looking thing now. But, you know what? I don't care at this point. I just want to be alive, so I will take however God wants me to look for now. I am sure He will make clear our next steps, just as He has made clear all of our other previous steps He has wanted us to take in this journey. I am feeling pretty good since the surgery. Today, I am running just a slight fever, but I am guessing it may take a couple of days for the infection to be completely out of my system. My only pain is where the drain tube is protruding. I know as soon as I can get that out, I will feel awesome. I have only taken normal over-the-counter doses of pain relievers since my surgery (one dose of normal tylenol last night and two doses of ibuprofen today). So, it really isn't too bad. My restrictions will likely only be in place for as long as I have the drain, so that is also great news! I have a sore throat and congestion, but that is likely from the breathing tube and the tube they placed in my trachea. They had to place a special tube in my trachea because I had eaten that morning (I didn't know I was going to be having surgery later that day). Apparently, that is why my surgery was scheduled for 2pm (6 hours after I ate). But, as a precaution, they place the trachea tube in case the food came up (to prevent at least most of it from entering my lungs). I guess I am experiencing the after of the tubes today. But, this is all temporary. I am SO HAPPY to be on my way to being completely healed. I was growing very tired of the open wound saga! I don't want to endure 6-7 weeks of hyperbaric treatment, so we are hoping that this "option 1" that God decided for us doesn't involve the hyperbaric treatment. The wound truly should heal better since there is nothing putting pressure on it from the inside. I am just busy praising God today--praising Him for our awesome friends and family, for making the decision for us so clear, and for healing me!

There you have it! The long saga from the last few days. Sometimes, it is difficult to understand the paths God chooses for us. I certainly wouldn't have chosen this difficult one for myself. But, there is a good reason for this path He has chosen for me. I may not completely understand it now, but I know I will likely understand it some day. I know I have continually grown in areas where I needed to grow and develop throughout this journey. As He allows more trials in my life, I grow stronger. I also have learned that loving others is so important. We have been loved and served so much through this journey and so I know first-hand what it feels like to be on the "served" end of things. I want to show that love and service to others! Thank you for your continuous prayers!

(Oh yeah, by the way, I had to cancel my PET scan. I will reschedule it once I know my wound is healing. I will post the new date on here once I know it.)